News item

Archive of: 2007

The Alliance is delighted that the Operating Framework for the year commencing April 2008 gives renewed impetus to implementation of the Carter recommendations, especially in relation to pooled budgets and designation of providers. The relevant extract states:

Specialised services commissioning

3.11 As a result of the Carter Review, the 10 Specialised Commissioning Groups (SCGs) were created to drive up the quality of specialised services, and prevent wasteful or even unsafe duplication of services. For that reason, we expect SCGs to create pooled budgets and to commission the majority of specialised services on their patch this year, extending this to all specialised services in 2009/10. This year, at least half of specialised services commissioned on each patch should be designated, in order to guarantee patient safety and ensure that scarce skills are used effectively. This must be done with a regard to published competition principles and rules.

3.12 In commissioning for world-class health services, SCGs should pay particular attention to areas where significant increases in demand are likely to lead to pressure on services. For example, demand for renal replacement therapy (dialysis and transplantation) is projected to rise by around 5 per cent per year until at least 2030. SCGs will wish to consider options for expanding the provision of satellite dialysis centres and offering more people the option of home dialysis, as well as expanding traditional acute dialysis units.

The Specialised Healthcare Alliance has submitted a response to Lord Darzi’s review of the NHS. This highlights the need to treat specialised services as an integral part of the NHS and to involve patients and their advocates in any reconfiguration of services with savings directed back into patient care. The Alliance looks forward to working with Lord Darzi and his team in ensuring that the Next Stage Review places appropriate emphasis on these matters in its final report and recommendations.

The Alliance has developed a policy statement on high cost treatments, pointing out that the NHS’s ability to help those in greatest need must not be weakened by the shift towards greater local accountability for the generality of services. With that in mind, the Alliance is seeking support for:

The standard and availability of specialised services being fundamental to a properly functioning National Health Service;

The new commissioning arrangements for specialised services being implemented at the earliest opportunity with sufficient pooled budgets attached;

For services and treatments not covered by Payment by Results, pooled budgets are imperative;

The Department should encourage more consistency of provision of specialised treatments across the country by developing the National Definition Set and including standards of care where appropriate;

Where treatment is not approved, the decision-making process should be more transparent and there should be a clear appeals process for patients with support provided;

The Government’s strategy for medical research needs to recognise the role of specialised services in providing a pathway for innovation.

The SHCA submitted evidence to the latest Health Select Committee inquiry into NICE. In particular:

The Specialised Healthcare Alliance considers NICE to have a critical role in ensuring that treatment delivered by the NHS is equitable, cost effective and to a uniformly high standard.

The existence in NICE of an independent national forum where decisions about cost effectiveness and prioritisation can be made in a consistent and fair manner is particularly important for patients with specialised medical conditions.

The Alliance believes the Institute’s evaluation system should be more transparent. Reform of the process may allow for a fairer consideration of some treatments. In the case of orphan or ultra-orphan treatments social value judgments are likely to be necessary which should rest with parliament.

The Specialised Healthcare Alliance welcomes the recent moves by NICE to ensure lifesaving drugs can be assessed more quickly and supports this process being extended to other technologies.

Unless greater consideration is given to how and when tariffs reflect NICE guidance, patients could face greater delays in accessing recommended treatments.

The Alliance believes that much greater priority should be attached to ensuring the implementation of NICE guidance. If NICE were to assume responsibility for this it would need additional resources.

The SHCA has responded to the latest consultation on the future of PbR. The Alliance sees the tariff system as important for both included and excluded treatments, insofar as the latter might be disadvantaged without robust funding arrangements to ensure stable provision. The slow pace of progress in relation to specialised services is therefore disappointing.